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Quantitative and qualitative analysis of [18F]FDG and [18F]FAZA positron emission tomography of head and neck cancers and associations with HPV status and treatment outcome

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Abstract

Purpose

While methods for imaging tumor hypoxia with positron emission tomography (PET) have been developed, optimal methods for interpreting and utilizing these datasets in the clinic remain unclear. In this study, we analyzed hypoxia PET images of head and neck cancer patients and compared imaging metrics with human papilloma virus (HPV) status and clinical outcome.

Methods

Forty-one patients treated as part of a phase III trial of the hypoxic cytotoxin tirapazamine (TROG 02.02) were imaged with PET using fluorodeoxyglucose (FDG) and fluoroazomycin arabinoside (FAZA). FDG and FAZA PET images were interpreted qualitatively and quantitatively, and compared with tumor T stage, HPV status, and treatment outcome using multivariate statistics.

Results

PET signals in the tumor and lymph nodes exhibited significant intra- and inter-patient variability. The FAZA hypoxic volume demonstrated a significant correlation with tumor T stage. PET-hypoxic tumors treated with cisplatin exhibited significantly worse treatment outcomes relative to PET-oxic tumors or PET-hypoxic tumors treated with tirapazamine.

Conclusion

Quantitative analysis of FAZA PET yielded metrics that correlated with clinical T stage and were capable of stratifying patient outcome. These results encourage further development of this technology, with particular emphasis on establishment of robust quantitative methods.

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Acknowledgments

This work was funded by the National Institutes of Health and the National Cancer Institute of the United States (R01 CA118582, P01 CA67166) and by the National Health and Medical Research Council of Australia.

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Authors and Affiliations

  1. Department of Radiation Oncology, Stanford University, 269 Campus Dr., CCSR South Rm. 1255A, Stanford, CA, 94305-5152, USA

    Edward E. Graves & Quynh-Thu Le

  2. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia

    Rodney J. Hicks, David Binns & Lester Peters

  3. Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia

    Mathias Bressel & Richard J. Young

  4. Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia

    Danny Rischin

Authors
  1. Edward E. Graves
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  2. Rodney J. Hicks
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  3. David Binns
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  4. Mathias Bressel
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  5. Quynh-Thu Le
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  6. Lester Peters
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  7. Richard J. Young
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  8. Danny Rischin
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Corresponding author

Correspondence to Edward E. Graves.

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Funding

This study was funded by the National Institutes of Health and the National Cancer Institute of the United States (R01 CA118582, P01 CA67166) and by the National Health and Medical Research Council of Australia.

Conflict of interest

E.E. Graves declares that he has no conflict of interest.

R.J. Hicks declares that he has no conflict of interest.

D. Binns declares that he has no conflict of interest.

M. Bressel declares that he has no conflict of interest.

Q.T. Le declares that she has no conflict of interest.

L. Peters declares that he has no conflict of interest.

R. Young declares that he has no conflict of interest.

D. Rischin declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Graves, E.E., Hicks, R.J., Binns, D. et al. Quantitative and qualitative analysis of [18F]FDG and [18F]FAZA positron emission tomography of head and neck cancers and associations with HPV status and treatment outcome. Eur J Nucl Med Mol Imaging 43, 617–625 (2016). https://doi.org/10.1007/s00259-015-3247-7

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  • DOI: https://doi.org/10.1007/s00259-015-3247-7

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